Disruption of the outer segments of the photoreceptors on OCT as a feature of vitamin A deficiency.

To describe the optical coherence tomography features of vitamin A deficiency.
Case series includes three male patients aged 50-66 years with vitamin A deficiency and visual symptoms ranging from 2-8 months. Examination included optical coherence tomography (OCT), fundus autofluorescence imaging (FAF), full-field electroretinography (ERG) and laboratory work-up.
Patient 1 had inoperable pancreatic neuroendocrine tumour and presented with worsening nyctalopia. The ERG showed absent rod function two months after the onset of symptoms, followed by a decrease of cone function eight months after the onset. OCT showed poorly distinguishable outer segments of the photoreceptors (OS) with the disappearance of the interdigitation zone (IZ). At that time vitamin A deficiency along with several other deficiencies was confirmed. After the initiation of parenteral nutrition, a substantial improvement of the patient’s overall well-being was noted and the OCT showed normalization of the retinal structure. Two other patients were diagnosed with vitamin A deficiency based on similar OCT features.
Disruption of the outer segments of the photoreceptors and the disappearance of the interdigitation zone on OCT may be helpful in recognition of vitamin A deficiency. Early detection and malnutrition evaluation are especially important in patients with a history of gastrointestinal disorders who may have several other underlying deficiencies. Treatment with either enteral or parenteral nutrition not only leads to resolution of visual symptoms but vastly improves their general condition and quality of life.